[1]胡星 蒋炘纹 蒋礼 雷迁(.尿液中性粒细胞明胶酶相关脂质运载蛋白和白细胞介素-6水平对心脏外科术后患者严重液体超负荷的风险价值[J].心血管病学进展,2024,(3):283.[doi:10.16806/j.cnki.issn.1004-3934.2024.03.020]
　HU Xing,JIANG Xinwen,JIANG Li,et al.Risk Value of Urinary Neutrophil Gelatinase-Associated Lipocalin and Interleukin-6 Levels on Severe Fluid Overload in Patients After Cardiac Surgery[J].Advances in Cardiovascular Diseases,2024,(3):283.[doi:10.16806/j.cnki.issn.1004-3934.2024.03.020]
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尿液中性粒细胞明胶酶相关脂质运载蛋白和白细胞介素-6水平对心脏外科术后患者严重液体超负荷的风险价值()
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《心血管病学进展》[ISSN:51-1187/R/CN:1004-3934]

卷:
期数:
2024年3期
页码:
283
栏目:
论著
出版日期:
2024-03-25

文章信息/Info

Title:
Risk Value of Urinary Neutrophil Gelatinase-Associated Lipocalin and Interleukin-6 Levels on Severe Fluid Overload in Patients After Cardiac Surgery
作者:
胡星1 蒋炘纹2 蒋礼1 雷迁2(
（1.成都市第三人民医院心脏外科ICU,四川 成都 610034;2.四川省医学科学院 四川省人民医院麻醉科,四川 成都 610072)
Author(s):
HU Xing1; JIANG Xinwen2; JIANG Li1; LEI Qian2
（1.Department of Cardiac Surgery ICU,The Third People’s Hospital of Chengdu,Chengdu 610034 ,Sichuan,China; 2. Department of Anesthesiology ,Sichuan Provincial People’s Hospital,Sichuan Academy of Medical Sciences,Chengdu 610072,Sichuan,China)
关键词:
心脏外科手术; 液体超负荷; 中性粒细胞明胶酶相关脂质运载蛋白; 白细胞介素-6
Keywords:
Cardiac surgery;  Fluid overload;  Neutrophil gelatinase-associated lipocalin;  Interleukin-6
DOI:
10.16806/j.cnki.issn.1004-3934.2024.03.020
摘要:
目的 分析尿液中性粒细胞明胶酶相关脂质运载蛋白（NGAL）和白细胞介素-6（IL-6）水平对心脏外科术后患者严重液体超负荷（FO）的风险价值。方法 选取2020年4月—2023年3月在成都市第三人民医院接受心脏外科手术的患者220例，根据术后24 h FO，将FO≥10%的患者记为A组，将FO＜10%的患者记为B组。分析两组一般资料，比较两组术前及术后尿液NGAL和IL-6水平，采用Logistic回归模型分析心脏外科术后24 h内患者发生严重FO的危险因素，绘制受试者工作特征（ROC）曲线，分析尿液NGAL、IL-6对患者发生严重FO的风险价值。亚组分析不同原发病对FO的影响。结果 A组男性ICU停留时间比例高于B组（P＜0.05），术前白蛋白水平及术后当天尿量低于B组（P＜0.05），两组体重指数、年龄、病程、手术时间、术中尿量、原发疾病类型、术前左室射血分数、肌酐水平、白细胞计数、血红蛋白水平、机械通气时间、体外循环时间，以及AKI、左心功能不全、高血压、心力衰竭、糖尿病占比比较无差异（P＞0.05）；两组术后2 h、术后12 h尿液NGAL和IL-6水平均高于术前（P＜0.05），术后12 h尿液NGAL和IL-6水平均高于术后2 h（P＜0.05），且A组术前、术后2 h及术后12 h均高于B组（P＜0.05）；Logistic回归分析发现，术前尿液NGAL和IL-6水平是心脏外科术后患者发生严重FO的危险因素（P＜0.05）；ROC结果显示，术前尿液NGAL和IL-6水平对心脏外科术后患者发生严重FO的最佳截断点非别为48.04 ng/mL和32.26 pg/mL，AUC分别为0.865和0.704，二者联合检测AUC为0.894。冠心病、先天性心脏病、心脏瓣膜病亚组之间FO情况、ICU停留时间、体外循环时间、术后当天尿量及术前NGAL和IL-6之间无显著差异（P均＞0.05）。结论 心脏外科术后患者尿液NGAL和IL-6水平异常升高，术前尿液NGAL和IL-6水平是其发生严重FO的危险因素。
Abstract:
Objective To analyze the risk value of urinary neutrophil gelatinase-associated lipocalin (NGAL) and interleukin-6 (IL-6) levels on severe fluid overload (FO) in patients after cardiac surgery. Methods A total of 220 patients underwent cardiac surgery in The Third People’s Hospital of Chengdu from April 2020 to March 2023 were enrolled. Patients with FO≥10% were classified into group A and FO＜10% into group B according to FO within 24 h after surgery. General data were analyzed and urinary NGAL and IL-6 levels were compared before and after surgery. Logistic regression model was used to analyze risk factors for severe FO after surgery. Receiver operating characteristic (ROC) curve was plotted to analyze the risk value of urine NGAL and IL-6 on severe FO. The influence of different primary diseases on FO was analyzed by subgroups. Results The proportion of male patients and stay time in ICU were higher in group A than group B (P＜0.05),while the preoperative albumin level and urine volume the day after surgery were lower (P＜0.05). There was no significant difference in body mass index, age, course of disease, operation time, urine volume during operation, primary disease types ,preoperative left ventricular ejection fraction,creatinine,leukocytes,hemoglobin,mechanical ventilation time,extracorporeal circulation time,intraoperative urine volume,the proportion of AKI,left cardiac insufficiency,hypertension,heart failure and diabetes between the two groups (P＞0.05). Urinary NGAL and IL-6 levels of two groups were increased (P＜0.05) at 2 h and 12 h after surgery,not only the higher at 12 h than 2 h (P＜0.05),but also the higher in group A than group B before surgery,after surgery and 12 h after surgery (P＜0.05). Logistic results showed urinary NGAL and IL-6 levels before operation were risk factors for severe FO in patients after cardiac surgery (P＜0.05). ROC results showed the optimal cut-off point of preoperative NGAL and IL-6 levels on severe FO after surgery was 48.04 ng/mL and 32.26 pg/mL,with the AUC of 0.865,0.704 respectively and 0.894 for their combined detection. There was no difference in FO,ICU stay time,cardiopulmonary bypass time,urine volume the day after operation and preoperative NGAL and IL-6 among the subgroups of coronary,congenital and valvular heart diseases (all P＞0.05). Conclusion Urinary NGAL and IL-6 were abnormally elevated in patients after cardiac surgery,the levels of which before surgery could be risk factors for severe FO.

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更新日期/Last Update: 2024-04-26